Dietary supplements in people with metastatic cancer who are experiencing malnutrition, cachexia, sarcopenia, and frailty: A scoping review

Cancer‐associated malnutrition, or cachexia, stemming from cancer or its treatments, is particularly prevalent in metastatic cancers, and is often interrelated with sarcopenia and frailty. Evidence suggests that dietary supplements play a role in managing these conditions. As metastatic cancer cells are associated with notable genomic and phenotypic alterations, response to dietary supplements may differ between metastatic and non‐metastatic cancers. However, research in this area is lacking. This scoping review aims to identify the dietary supplements that have been studied in patients with metastatic cancers and malnutrition‐related conditions, along with their proposed effects, mechanisms, outcome measures, and tools used. A systematic search was conducted across databases, including MEDLINE, EMBASE, CINAHL, and clinical trial registries. Of the initial 6535 records screened, a total of 48 studies were included, covering a range of dietary supplements— vitamins, minerals, antioxidants, proteins, amino acids, fatty acids, fiber, and others. While the types of dietary supplements included varied across cancer types, omega‐3 and carnitine were investigated most often. Proposed relevant attributes of dietary supplements included their antioxidant, anti‐inflammatory, anti‐cancer, and immunomodulatory properties. Overall, there was a paucity of interventional studies, and more randomized controlled trials are warranted

A healthy eating index to measure diet quality in pregnant women in Singapore: a cross-sectional study

10.1186/s40795-015-0029-3BMC Nutrition1391-11GUSTO (Growing up towards Healthy Outcomes

Effectiveness of combined exercise and nutrition interventions in prefrail or frail older hospitalised patients: a systematic review and meta-analysis

Objectives To determine the effectiveness of combined exercise-nutrition interventions in prefrail/frail hospitalised older adults on frailty, frailty-related indicators, quality of life (QoL), falls and its cost-effectiveness.Design Randomised controlled trials (RCTs) of combined exercise-nutrition interventions on hospitalised prefrail/frail older adults ≥65 years were collated from MEDLINE, Emcare, CINAHL, Ageline, Scopus, Cochrane and PEDro on 10 October 2019. The methodological quality was appraised, and data were summarised descriptively or by meta-analysis using a fixed effects model. The standardised mean difference (SMD) or difference of means (MD) with 95% CIs was calculated.Results Twenty articles from 11 RCTs experimenting exercise-nutrition interventions on hospitalised older adults were included. Seven articles were suitable for the meta-analyses. One study had low risk of bias and found improvements in physical performance and frailty-related biomarkers. Exercise interventions were mostly supervised by a physiotherapist, focusing on strength, ranging 2–5 times/week, of 20–90 min duration. Most nutrition interventions involved counselling and supplementation but had dietitian supervision in only three studies. The meta-analyses suggest that participants who received exercise-nutrition intervention had greater reduction in frailty scores (n=3, SMD 0.25; 95% CI 0.03 to 0.46; p=0.02) and improvement in short physical performance battery (SPPB) scores (n=3, MD 0.48; 95% CI 0.12 to 0.84; p=0.008) compared with standard care. Only the chair-stand test (n=3) out of the three SPPB components was significantly improved (MD 0.26; 95% CI 0.09 to 0.43; p=0.003). Patients were more independent in activities of daily living in intervention groups, but high heterogeneity was observed (I2=96%, p<0.001). The pooled effect for handgrip (n=3)±knee extension muscle strength (n=4) was not statistically significant. Nutritional status, cognition, biomarkers, QoL, falls and cost-effectiveness were summarised descriptively due to insufficient data.Conclusions There is evidence, albeit weak, showing that exercise-nutrition interventions are effective to improve frailty and frailty-related indicators in hospitalised older adults

Barriers and Enablers to a Hospital-to-Home, Combined Exercise and Nutrition, Self-Managed Program for Pre-Frail and Frail Hospitalised Older Adults

Introduction: Self-managed exercise and nutrition interventions can alleviate pre-frailty and frailty but understanding of adherence to them is lacking. This study aimed to explore the experiences of, and barriers and enablers to, a hospital-to-home self-managed combined exercise and nutrition program for hospitalised older adults living with pre-frailty and frailty. Methods: A hybrid approach to data- and theory-driven descriptive thematic analysis identified experiences, barriers, and enablers to participation in a 3-month, self-managed, exercise–nutrition, hospital-to-home frailty-support program. Pre-frail and frail older adult patients ≥ 65 years admitted to the acute medical unit at a South Australian tertiary hospital were recruited. Individual semi-structured interviews were audio-recorded, transcribed verbatim, and analysed descriptively, using the Theoretical Domains Framework. Results: The nutrition component of the program found 11 common barriers and 18 common enablers. The exercise component included 14 barriers and 24 enablers. Intentions, Social influences, Environmental context/resource and Emotions served as primary barriers towards adherence to both components. Common enablers for both components included Knowledge, Social identity, Environmental context/resource, Social influences, and Emotions. Conclusions: This research revealed important factors affecting adherence to a self-managed exercise–nutrition program in pre-frail and frail older adults within the environment, resources, and emotion domains that should be considered when designing other intervention programs in this population group

Information Resources for Pancreatobiliary Cancer Survivors: A Review of Australian Online Resources

Pancreatobiliary cancer survivors experience a range of disease and treatment related symptoms including weight loss, sarcopenia, digestive complications, fatigue, pain, functional limitations and jaundice. Psychological health is particularly impacted. Around 96% of Australians with pancreatic cancer have unmet needs. Online resources can potentially meet informational and knowledge needs, provide access to appropriate services and assist with the navigation process. It is first important to understand the online resources that are currently available in order to identify gaps and guide improvements. This project will conduct a review of current Australian online resources developed for pancreatobiliary cancer survivors

Correction: The Impact of Macronutrients on Retinal Microvasculature among Singapore Pregnant Women during the Mid-Late Gestation.

[This corrects the article DOI: 10.1371/journal.pone.0160704.]

The Impact of Macronutrients on Retinal Microvasculature among Singapore Pregnant Women during the Mid-Late Gestation

<div><p>Background</p><p>Imbalanced macronutrient intakes can induce impairment of endothelial and vascular function, and further lead to metabolic and cardiovascular disease. However, little is known about the influence of such diets on endothelial and vascular dysfunction in pregnant women, even though high-fat diet is a known risk for pregnancy complications such as gestational diabetes and pre-eclampsia.</p><p>Objective</p><p>We aimed to assess the association between maternal macronutrient intakes (protein, fat and carbohydrates), dietary quality and retinal microvascular changes in a multi-ethnic Asian mother-offspring cohort.</p><p>Methods</p><p>Pregnant women (n = 614) with singleton pregnancies were recruited during their first trimester from June 2009 to Sep 2010. Maternal diet quality and macronutrient intakes, expressed as a percentage of total energy during pregnancy, were ascertained using 24 hr recalls and 3 d food diaries at 26–28 weeks gestation. Retinal examination was completed at the same clinic visit. Dietary quality was assessed and scored using the Health Eating Index in Asian Pregnant women (HEI-AP), while macronutrients intakes ware expressed as percentages of total energy and further log transformed for analysis. Associations were examined cross-sectionally by substitution models with the use of multiple linear regression.</p><p>Results</p><p>In adjusted model, each 20 points decrease in HEI-AP score was associated with a significant increase of 1.70 μm (p<0.05) in retinal venular calibre. Each 0.1 log increase in percentage of total fat intake was associated with a significant increment of 1.84 μm (p<0.05) in retinal venular caliber. Additionally, each 0.1 log increase in percentage of mono-unsaturated fat intake was associated with an increment of 1.84 μm (p<0.01) in retinal venular caliber.</p><p>Conclusions</p><p>In this cross-sectional study, we found that women with higher fat and lower protein intakes, and lower diet quality tended to have wider retinal venular caliber, which is suggestive of suboptimal microvasculature.</p></div

Examples of retinal venular assessment from two subjects with different diet quality.

<p>Subject in Fig 2a in the upper panel has a unhealthier diet pattern than the subject in Fig 2b. in the lower panel. Comparisons between 2a and 2b are listed below: total mono-unsaturated fat (MUFA) percentage—80.25% vs. 13.45%; total fat intake percentage– 41.8% vs. 36.9%; Health Eating Index for Asian Pregnant Women (HEI-AP)– 27.20 vs. 38.70; central retinal venular equivalent (CRVE)– 180.50 μm vs 145.63 μm.</p

Associations between Saturated fat and retinal vascular caliber among pregnant women during 26–28 weeks’ gestation.

<p>Associations between Saturated fat and retinal vascular caliber among pregnant women during 26–28 weeks’ gestation.</p